Abstract
BackgroundLesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.MethodWe conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and s, the International Bibliography of the Social Sciences, Sociological s, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.ResultsOf 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54–2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51–4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97–5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).ConclusionLGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.
Highlights
Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people
LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people
To undertake a systematic review of the international research literature to establish whether LGB people are at higher risk of mental disorder, substance misuse, suicide, suicidal ideation and Deliberate self harm (DSH) than heterosexual people and to quantify this risk
Summary
Gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people. Gay and bisexual (LGB) people appear to be at greater risk than heterosexual people of mental disorders and suicidal behaviour [1,2]. LGB people are subject to institutionalised prejudice, social stress, social exclusion (even within families) and anti-homosexual hatred and violence and often internalise a sense of shame about their sexuality [1,2]. Lifestyle factors such as alcohol and drugs misuse increase the risk of morbidity [1] as well as suicide attempts [3]. Specific methodological obstacles include variation in the definition of sexual orientation, DSH and mental illness; difficulty in achieving random samples; reliance on participants' recall; unwillingness of people to be open about their sexual orientation; lack of information on sexuality in suicide victims who are part of psychological post mortem studies; the complexity of choosing appropriate comparison groups and poor or absent adjustment for confounding influences such as substance use and personality factors
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